递增式血液透析对终末期肾病患者肾功能、微炎症及死亡率的影响

doi:10.3877/cma.j.issn.2095-3216.2022.04.003

目的

研究递增式血液透析(IHD)对终末期肾病(ESRD)患者肾功能、微炎症及死亡率的影响。

方法

选取2017年7月至2021年6月于我院行血液透析(HD)治疗的ESRD患者84例，按照随机数字表法将84例ESRD患者分为递增组(n＝42)与常规组(n＝42)。治疗前及治疗6个月后，观察两组透析充分及生存情况、血尿素氮(BUN)、胱抑素C(CysC)、血清肌酐(Scr)、残余尿量(RUV)、尿素氮下降率(URR)、Kt/V等肾功能指标，血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和β2微球蛋白(β2-MG)等微炎症指标，以及透析期间不良反应。

结果

与常规组相比，递增组透析充分率增高，死亡率降低(P<0.05)。治疗6个月后，与常规组相比，递增组的BUN、CysC、Scr、RUV降低；URR、Kt/V增高(P<0.05)；血清CRP、IL-6、TNF-α及β2-MG水平降低(P<0.05)；不良反应发生率降低(P<0.05)。

结论

IHD可以保护ESRD患者的残余肾功能，抑制机体微炎症，降低不良反应率和死亡率。

关键词: 递增式血液透析, 终末期肾病, 肾功能, 微炎症, 死亡率

Objective

To investigate the effect of incremental hemodialysis (IHD) on renal function, microinflammation, and mortality in end-stage renal disease (ESRD) patients.

Methods

A total of 84 ESRD patients who received HD treatment in our hospital from July 2017 to June 2021 were selected. By means of the random number table method, the patients were divided into the incremental group (n=42) and the routine group (n=42). Before and 6 months after the treatment, the following indexes were observed, including dialysis adequacy, survival, BUN, cystatin C (CysC), serum creatinine (Scr), residual urine volume (RUV), urea nitrogen reduction rate (URR), Kt/V, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and β2 microglobulin (β2-MG), as well as adverse reactions during dialysis.

Results

Compared with the routine group, the incremental group showed higher dialysis adequacy rate and lower mortality rate (P<0.05). After 6 months of the treatment, compared with the routine group, the incremental group displayed lower levels of BUN, CysC, Scr, and RUV (P<0.05), higher levels of URR and Kt/V (P<0.05), and lower levels of serum CRP, IL-6, TNF-α and β2-MG (P<0.05), as well as lower rate of adverse reactions (P<0.05).

Conclusion

IHD could protect the residual kidney function of ESRD patients, inhibit the body′s microinflammation, and reduce both the adverse reaction rate and mortality rate.

Key words: Incremental hemodialysis, End-stage renal disease, Renal function, Microinflammation, Mortality rate

表1 两组患者基线资料比较

基线资料	递增组(n＝42)	常规组(n＝42)	χ²/t值	P值
性别(男/女)	22/20	24/18	0.190	0.663
年龄(岁)	61.23±6.42	61.31±6.48	0.057	0.955
疾病类型(慢性肾小球肾炎/糖尿病肾病/高血压肾病)	20/17/5	23/15/4	0.445	0.800
体重(kg)	58.09±6.15	58.52±6.21	0.319	0.751
收缩压(mmHg)	142.61±4.20	142.64±4.23	0.033	0.974
舒张压(mmHg)	87.28±5.09	87.31±5.12	0.027	0.979
血红蛋白(g/L)	80.38±8.31	80.43±8.35	0.028	0.978
白蛋白(g/L)	4.29±0.45	4.32±0.47	0.299	0.766
血磷(mmol/L)	1.86±0.20	1.83±0.18	0.723	0.472
血钙(mmol/L)	2.06±0.23	2.08±0.25	0.382	0.704
iPTH(μg/L)	243.07±27.23	247.75±27.26	0.787	0.434
空腹血糖(mmol/L)	15.67±1.92	15.63±1.89	0.096	0.924
餐后2 h血糖(mmol/L)	27.09±2.83	27.01±2.81	0.130	0.897

表1 两组患者基线资料比较

基线资料	递增组(n＝42)	常规组(n＝42)	χ²/t值	P值
性别(男/女)	22/20	24/18	0.190	0.663
年龄(岁)	61.23±6.42	61.31±6.48	0.057	0.955
疾病类型(慢性肾小球肾炎/糖尿病肾病/高血压肾病)	20/17/5	23/15/4	0.445	0.800
体重(kg)	58.09±6.15	58.52±6.21	0.319	0.751
收缩压(mmHg)	142.61±4.20	142.64±4.23	0.033	0.974
舒张压(mmHg)	87.28±5.09	87.31±5.12	0.027	0.979
血红蛋白(g/L)	80.38±8.31	80.43±8.35	0.028	0.978
白蛋白(g/L)	4.29±0.45	4.32±0.47	0.299	0.766
血磷(mmol/L)	1.86±0.20	1.83±0.18	0.723	0.472
血钙(mmol/L)	2.06±0.23	2.08±0.25	0.382	0.704
iPTH(μg/L)	243.07±27.23	247.75±27.26	0.787	0.434
空腹血糖(mmol/L)	15.67±1.92	15.63±1.89	0.096	0.924
餐后2 h血糖(mmol/L)	27.09±2.83	27.01±2.81	0.130	0.897

表2 两组透析充分及生存情况比较[例(%)]

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
透析充分	36(85.71)	28(66.67)	4.150	0.042
死亡	1(2.38)	8(19.05)	－	0.029

表2 两组透析充分及生存情况比较[例(%)]

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
透析充分	36(85.71)	28(66.67)	4.150	0.042
死亡	1(2.38)	8(19.05)	－	0.029

表3 两组肾功能指标比较(±s)

指标	时间	递增组	常规组	t值	P值
BUN(mmol/L)	治疗前	11.28±1.32	11.24±1.30	0.140	0.889
	治疗6个月后	7.19±0.74^a	8.87±0.92^a	8.409	<0.001
CysC(mg/L)	治疗前	2.98±0.31	2.96±0.30	0.301	0.765
	治疗6个月后	1.47±0.16^a	1.78±0.19^a	7.358	<0.001
Scr(μmol/L)	治疗前	99.87±10.23	98.95±10.20	0.413	0.681
	治疗6个月后	80.37±8.34^a	88.74±9.11^a	3.978	<0.001
URR(%)	治疗前	50.97±5.43	51.05±5.47	0.067	0.947
	治疗6个月后	71.07±7.34^a	65.92±6.84^a	3.327	0.001
Kt/V	治疗前	0.95±0.11	0.96±0.12	0.398	0.692
	治疗6个月后	1.42±0.16^a	1.30±0.15^a	3.546	0.001
RUV(ml)	治疗前	1649.07±171.29	1641.26±169.28	0.210	0.834
	治疗6个月后	379.98±40.32^a	553.76±58.95	15.769	<0.001

表3 两组肾功能指标比较(±s)

指标	时间	递增组	常规组	t值	P值
BUN(mmol/L)	治疗前	11.28±1.32	11.24±1.30	0.140	0.889
	治疗6个月后	7.19±0.74^a	8.87±0.92^a	8.409	<0.001
CysC(mg/L)	治疗前	2.98±0.31	2.96±0.30	0.301	0.765
	治疗6个月后	1.47±0.16^a	1.78±0.19^a	7.358	<0.001
Scr(μmol/L)	治疗前	99.87±10.23	98.95±10.20	0.413	0.681
	治疗6个月后	80.37±8.34^a	88.74±9.11^a	3.978	<0.001
URR(%)	治疗前	50.97±5.43	51.05±5.47	0.067	0.947
	治疗6个月后	71.07±7.34^a	65.92±6.84^a	3.327	0.001
Kt/V	治疗前	0.95±0.11	0.96±0.12	0.398	0.692
	治疗6个月后	1.42±0.16^a	1.30±0.15^a	3.546	0.001
RUV(ml)	治疗前	1649.07±171.29	1641.26±169.28	0.210	0.834
	治疗6个月后	379.98±40.32^a	553.76±58.95	15.769	<0.001

表4 两组微炎症指标比较(±s)

指标	时间	递增组	常规组	t值	P值
CRP(mg/L)	治疗前	10.84±1.23	10.81±1.21	0.113	0.911
	治疗6个月后	4.97±0.52^a	5.86±0.61^a	6.542	<0.001
IL-6(ng/L)	治疗前	8.43±0.87	8.39±0.86	0.212	0.833
	治疗6个月后	3.86±0.41^a	4.58±0.48^a	6.720	<0.001
TNF-α(μg/L)	治疗前	42.95±4.50	42.86±4.58	0.091	0.928
	治疗6个月后	26.11±2.82^a	32.17±3.33^a	8.186	<0.001
β2-MG(mg/mL)	治疗前	15.37±1.81	15.32±1.79	0.127	0.899
	治疗6个月后	8.57±0.93^a	10.65±1.22^a	8.035	<0.001

表4 两组微炎症指标比较(±s)

指标	时间	递增组	常规组	t值	P值
CRP(mg/L)	治疗前	10.84±1.23	10.81±1.21	0.113	0.911
	治疗6个月后	4.97±0.52^a	5.86±0.61^a	6.542	<0.001
IL-6(ng/L)	治疗前	8.43±0.87	8.39±0.86	0.212	0.833
	治疗6个月后	3.86±0.41^a	4.58±0.48^a	6.720	<0.001
TNF-α(μg/L)	治疗前	42.95±4.50	42.86±4.58	0.091	0.928
	治疗6个月后	26.11±2.82^a	32.17±3.33^a	8.186	<0.001
β2-MG(mg/mL)	治疗前	15.37±1.81	15.32±1.79	0.127	0.899
	治疗6个月后	8.57±0.93^a	10.65±1.22^a	8.035	<0.001

表5 两组不良反应比较[例(%)]

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
胃肠道反应	1(2.38)	1(2.38)
营养不良	1(2.38)	3(7.14)
低蛋白血症	1(2.38)	1(2.38)
瘙痒	2(4.76)	3(7.14)
心血管疾病	1(2.38)	5(11.90)
贫血	1(2.38)	4(9.52)
合计	7(16.67)	17(40.48)	3.833	0.016

表5 两组不良反应比较[例(%)]

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
胃肠道反应	1(2.38)	1(2.38)
营养不良	1(2.38)	3(7.14)
低蛋白血症	1(2.38)	1(2.38)
瘙痒	2(4.76)	3(7.14)
心血管疾病	1(2.38)	5(11.90)
贫血	1(2.38)	4(9.52)
合计	7(16.67)	17(40.48)	3.833	0.016

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Effect of incremental hemodialysis on renal function, microinflammation and mortality in end-stage renal disease patients

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Effect of incremental hemodialysis on renal function, microinflammation and mortality in end-stage renal disease patients